Middle school can be a game-changer for kids who have ADHD. While many children learn to deal with their symptoms in elementary school—or are simply able to keep up with school at that point—the increased workload as well as having to move from class to class in middle school often creates stress and organizational issues that make managing ADHD more difficult.

What’s more, ADHD symptoms can change in adolescence. Medications that may have been effective can stop working as well. And children who are hyperactive or inattentive (or both) can start to exhibit symptoms of coexisting conditions like depression or anxiety that parents may have been unaware of before.

How can parents and children manage middle school with ADHD? Maintaining consistent routines, working with the school and your child’s doctor, and watching for changes can help.

Establishing Home Routines

As with younger children, establishing and maintaining routines for tweens and teens with ADHD is an important part of their ability to succeed. Adolescents with ADHD can have trouble getting ready for school in the morning. They often forget to take important things to school like their book bag, homework, and clothes for gym. Mornings can be chaotic and create stress for both parents and children. The goal is to have your child ready to leave for school with everything he needs when he gets there. The first step is to determine what he will need for school. This might be best accomplished the night before as part of his bedtime routine. Until he is able to do this for himself, you will need to help. Ask him about each of his classes to determine if there is homework or a project due. Discuss extracurricular activities such as sports to make sure he has completed everything he needs or has the appropriate supplies or equipment ready. Organize everything and place it beside the door or in the car, if appropriate. He should go to bed at the same time each night knowing he is ready for the next day.

Provide Helpful Tools

Organizational tools are another critical part of helping your ADHD child succeed in middle school. Using color-coded binders for each class is a helpful system. It is easier for your child to remember to turn in homework and to get out what she needs if everything is organized the same way for each class. This can become part of the structure and predictability she needs. For example, a binder for science can contain a green spiral notebook for notes and a green folder for handouts or homework. History, English, and math can each use a different color. The colors help students choose the correct binder quickly, and their papers are more likely to be stored in the right place. This practice takes time to learn, and your child might need a lot of help in the beginning keeping everything in its place. The time will be well-spent, however, because the end result is fewer missing assignments.

Your child might also benefit from using a small journal or notebook to keep track of her assignments. She can jot down a few words to remind her of each task she needs to do; for example, a student in science class can simply write “science.” Later, when doing homework, she will see that she does have science homework to do. (This assumes that she has a syllabus or online source with the details of what is due for science.)

Work With the School

Communicating with the school—and generally, a team of teachers—can also become trickier in middle school. It’s a good idea to set up a meeting early in the school year to discuss your child with his team; it will help his teachers recognize what to watch for.

Some children with ADHD are able to receive services under either Section 504 of the U.S. Rehabilitation Act or the Individuals With Disabilities Education Act (IDEA), both of which require educators to work with parents to develop a plan for how the school will meet the student’s educational needs. This can mean classroom accommodations like modified homework assignments; more test-taking time or a quieter area to take tests; increased computer use for written assignments; and use of tools like audiotapes and calculators.

The plan created for a child who qualifies for special education services is called an individualized education program. To qualify for an IEP, a child must have one or more of 13 disabilities listed in IDEA and require specialized services in order to be successful in school. The IEP will list your child’s educational needs and goals and determine what services are necessary to meet them. The IEP team should include your child’s teachers; the school guidance or mental health counselor or psychologist; speech, language, or occupational therapists; special education teachers; and you. Because medication is often a primary treatment for ADHD, your child’s personal physician and the school nurse should also be kept in the loop. To receive services under Section 504, a child must have an issue that limits their performance in school (or other life activity). Sometimes children with learning disabilities or attention issues qualify for additional help under the 504 plan when they would not qualify for services through an IEP.

If you feel that your child needs additional help in order to be successful in school, you should write a letter to the school requesting a formal evaluation. The school psychologist will contact you to make sure you understand the process and how a 504 plan and an IEP differ. Keep in mind that either plan should be individualized to meet your child’s needs. No two plans should be exactly alike because no two children are exactly alike.

The evaluation process can take several months. Parents are involved in helping determine and approve the accommodations. This process is complicated. It is a good idea to solicit the help of a friend who has been through it before who can go with you to the meetings with your child’s team. Your friend can help you think of questions to ask and make sure you remember to say everything you need to say to advocate for your child.

Talk to the Doctor

While many elementary-age children are helped by taking medication for ADHD, some find that the medication loses its effectiveness as kids get older. The dosage may need to change because your child has grown. Additionally, adolescents often complain that the medications affect their appetite and keep them awake at night. If these issues are true for your teen, it is time for a visit to her doctor. There are multiple kinds of ADHD medications, and it is worth the time to try a different one if there are side effects your child does not like.

As many as two-thirds of children with ADHD also have other coexisting conditions like depression, obsessive compulsive disorder, and sleep issues, and adolescence is a time when such issues can become more prevalent. During adolescence, normal hormone changes are occurring. It is difficult or impossible to tell what causes these coexisting conditions. If you’re finding any of these issues, schedule a meeting with your child’s doctor. She might recommend a switch of medication, that your child meet with a therapist, or both.

Navigating the middle school years is not easy for parents or their children. It can be especially difficult if your child has ADHD. But with the proper support systems in place, it can be a rewarding time together as you watch your child grow into an independent and mature high school student.